Innovation in Patient Safety and Quality at the Local Level - Vidant Health, Greenville, N.C.

Gail L. Warden was recognized for his continued work to improve and ensure the well-being of hospitalized patients. Mr. Warden oversaw the creation of Henry Ford Health System, an institution known for its quality patient care, bench-to-bedside research and outstanding education program. Among his many notable accomplishments, he served on an Institute of Medicine committee that issued two groundbreaking reports that prompted health care to identify and fix medical errors, minimizing patient risk and striving to achieve “perfect” health care.

The Institute for Clinical Systems Improvement, the Minnesota Hospital Association and Stratis Health were recognized for their Reducing Avoidable Readmissions Effectively (RARE) campaign, a large-scale health care change initiative that engages hospitals and care providers in Minnesota. The 82 participating hospitals in the RARE Campaign account for more than 85 percent of the annual statewide hospital readmissions and to date have prevented 5,441 readmissions over a two-year period.

Anthem Blue Cross, the National Health Foundation, the Hospital Association of Southern California, the Hospital Association of San Diego & Imperial Counties and the Hospital Council of Northern & Central California were recognized for their “Patient Safety First…a California Partnership for Health” initiative, which unites key stakeholders from different geographic regions within California to improve quality of care, save lives by targeting zero avoidable medical errors and reduce health care costs to allow for reinvestment into the system. Phase one results showed that 182 hospitals were engaged, and more than 3,500 lives and $63 million were saved.

Vidant Health was recognized for its system wide quality transformation focused on patient safety training following a serious blood event that resulted in a patient death in 2006. In response to the event, Vidant Health outlined a series of interventions to improve patient safety, including board literacy in quality, an aggressive transparency policy, patient–family partnerships and leader and physician engagement. The interventions resulted in an 83 percent reduction in serious safety events and a 62 percent reduction in hospital-associated infections.

To improve handoff communication between the inpatient and outpatient settings, an electronic medical record–integrated handoff tool was designed and implemented at the medicine service at the San Francisco Veterans Affairs Medical Center. At 15 months after the tool’s rollout, 86 percent (129/150) of patients had a completed handoff at discharge.

For hip-fracture patients, a preauthorized osteoporosis consultation was triggered via a brief query in admission orders or by the orthopedic service nurse practitioner. Only 3 to 21 percent of 71 baseline patients (on-demand consultation) received the desired evaluation, documentation, treatment or outpatient follow-up. For 61 intervention patients (triggered-consultation), performance increased by 52 to 76 percent on all parameters except outpatient follow-up. Yet despite the effectiveness of triggered consultation, multimodal layered interventions may achieve even better results and address several identified barriers.

Operating room nurse managers at all 122 Veterans Health Administration hospitals who completed a Medical Team Training program that addressed preoperative briefings and postoperative debriefings (B/Ds) were surveyed 23–52 months after. For the 42 respondents (34 percent response rate), 40 (95 percent) reported some degree of B/D, of whom 27 (68 percent) reported maintaining the same level of B/D since a follow-up interview one year after the end of training. The results suggest that communication improvements following medical team training may be sustained for several years.

The Joint Commission Journal on Quality and Patient Safety, published monthly by Joint Commission Resources, is a peer-reviewed journal, available by subscription, which serves as a forum for practical approaches to improving quality and safety in health care.

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